Risk Factors for Falls During Treatment of Late-Life Depression
J Clin Psychiatry 2002;63(10):936-941
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Prior studies have found that
antidepressant medications are associated with an increased risk
of falling in elderly persons. However, little is known about the
prevention of falls during treatment for depression in elderly
persons. This study evaluated the time course and potential risk
factors for falls in a treatment protocol for late-life
depression to identify specific at-risk periods and risk factors
for falls in this population.
Method: One hundred four subjects aged 69 years
and over were treated in a protocolized manner using paroxetine
and interpersonal psychotherapy. Those who did not respond
received augmentation therapy with bupropion, nortriptyline, or
lithium. Subjects were assessed at baseline and weekly during
treatment; demographic and clinical characteristics of those who
experienced a fall during treatment were compared with those who
did not fall. Cox proportional hazards models were used to define
risk factors for falls in univariate and multivariate models.
Results: During a mean of 21 weeks of treatment,
40 subjects (38%) fell. About half (53%) of the subjects fell
during the first 6 weeks of treatment. In the multivariate model,
memory impairment and orthostatic changes in blood pressure
during treatment were risk factors for falling. Additionally,
augmentation with bupropion appeared to be a risk factor for
falls in univariate analysis, but this result is preliminary due
to the small number of subjects who took bupropion.
Conclusion: Increased monitoring for falls is
warranted during the acute treatment of late-life depression.
When treating such patients, clinicians should be especially
watchful of those with memory impairments or those who develop
orthostatic blood pressure changes; orthostatic blood pressure
should be measured throughout acute treatment. Additionally,
augmenting paroxetine with bupropion may also increase the risk
of falls, and this medication combination should be used with
caution in elderly patients.